Hampshire and Isle of Wight Air Ambulance

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This is the first assessment for this service. This key question has been rated outstanding.

Staff carefully assessed people’s needs to ensure care was delivered using evidence-based guidance to give the best outcomes. This meant the service acted to improve patient outcomes.

The case review process meant every single interaction with a patient provided an opportunity to improve upon care and treatment. The oversight of this process enabled the service and staff to consider each patient experience. Patient feedback shared with the service indicated patients and their families acknowledged the prompt and effective treatment they received. Patients also shared updates about their improving health where this was the case. However, even when the outcome for the patient was not positive, families had contacted the service to share their appreciation of the hard work done by staff members to give the best care to their loved one.

The service worked closely with other healthcare providers, including all the emergency services, to ensure it was part of a system of health and care and a multidisciplinary team approach. Patient feedback, research and monitoring was used to improve outcomes for patients. Staff followed legal frameworks around consent and understood patients’ rights and standards. People’s feedback described the service as exceptional and distinctive.

This service scored 100 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We scored the service as 4. The evidence showed an exceptional standard. The service always made sure people’s care and treatment was effective by thoroughly assessing and reviewing their health, care, wellbeing, and communication needs with them.

Staff told us how monitoring pain levels in patients a key element of their work was. This was due to the often significant and critical nature of some patient incidents. Due to the rapid response needed in some incidents, staff did not use pain management assessment. Staff focused on stabilising and administering appropriate analgesia for patients requiring immediate pain relief. Staff had advanced training on administering controlled medicines to control pain and had clear clinical standards to ensure patients were as comfortable as possible. All cases of advanced analgesia and procedural sedation were reviewed as part of the case review process focusing on choice and quality of analgesic technique.

The use of advanced analgesia also meant that pain was more controlled for cases such as difficult extraction than it may be by ambulance staff. We saw examples of 2 patient cases where advanced analgesia had been used to provide significant pain relief in patients who had uncontrolled pain prior to air ambulance attendance.

Patients and their families said how the service had communicated care in a way they understood and felt a part of. They said staff had taken time to explain what they were doing and why, this mattered to people both in the moment, and afterwards. The aftercare team contacted patients and loved ones to provide full explanations of care given, where required to ensure information, actions taken and the treatment given was well understood.

Staff told us they considered patients' needs and made any adjustments required for their individual care. For example, staff were trained in administering insulin to diabetic patients. Staff said they could make use of various communication tools, such as telephone translation services to enable them to communicate effectively.

We reviewed 5 patient care journeys during our inspection. The patients’ records showed a range of presenting conditions such as uncontrolled seizures to a transfer of a patient from the Isle of Wight to a mainland acute trust due to a life-threatening condition that required immediate specialist care. Records showed staff had completed comprehensive assessments of the patient in a timely manner and provided safe care at all times.

The service had policies and standard operating procedures to ensure patients' individual needs were assessed. If the patient had been reviewed by ground paramedics before arrival of the air ambulance or critical care crew, there was a full handover of relevant needs and treatment. Staff used monitoring equipment and dynamic risk assessments to monitor a patients' changing needs. Patient monitoring was uploaded to the electronic patient record and would provide a national early warning score(NEWS), or paediatric early warning score PEWS score. This enabled them to quickly adapt a patient’s treatment, particularly if there was deterioration while transporting them.

We scored the service as 4. The evidence showed an exceptional standard. The service always planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation. They worked to develop evidence-based good practice and standards.

Staff participated in clinical audit, benchmarking and quality improvement initiatives. Staff at the service had contributed and were referenced in clinical guidance and research at national and international levels. This included development of national evidence-based care guidelines, cross working collaboration and research.

Staff told us there were policies which they described as being clear, easy to follow and which were supported by guidance from standard operating procedures. These had been developed by the service, so they reflected national guidance for helicopter emergency medicine services (HEMS) and also reflected the demographic of patients they supported. We reviewed these and saw they used current evidence-based practice to support treating and caring for patients.

Policies were regularly reviewed by the clinical quality and senior leadership team. The service held monthly meetings to help maintain effective oversight and ensure it was fully up to date with all guidance and practise. Any updates to national guidelines would be referenced at weekly meetings and shared with staff.

The service had access to the full range of specialists required to meet the needs of patients in the service. Staff were experienced and qualified and had the right skills and knowledge to meet the needs of every patient. Staff kept up to date with changes to practice. There was a dedicated clinical lead for paramedics and medical staff to ensure all updates and renewed guidance was always based on best practice guidance.

Staff were given roles and responsibilities for various specialities to support focused work on best practice guidance and improvement.There were clear workstreams with defined areas of focus such as blood and medicines, dispatch, equipment, education, and performance.

Staff could submit suggestions through an online form if they had ideas on how current processes could be improved to better fit the service’s specific requirements. These were then assessed by senior leaders and, if it was agreed changes would improve patient experience, then guidance could be updated.

We scored the service as 4. The evidence showed an exceptional standard. The service always worked well across teams and services to support people. They shared thorough assessments of people’s needs when they moved between different services.

The teams had effective working relationships, including good handovers, with other relevant teams, such as the NHS ambulance services they worked alongside.

The service liaised with local emergency services and trauma centres to enable the most efficient transfer of patients to the appropriate place of care. Staff told us the service had close ties with acute hospitals and could obtain feedback about ongoing patient care. To support better outcome feedback for staff, the air ambulance team had developed QR code cards. QR code stands for Quick Response Code, a type of barcode that can store various types of information and be scanned by smartphones. These were given by air ambulance staff to give to staff from other services when patient’ care was handed over to air ambulance staff. By following the form linked to the QR code, staff were provided a full updated outcome of the patient they had cared for. Staff told us this helped foster better relationships with the paramedic staff on the ground as they were still able to see the outcome of a patient which they had cared for.

Staff at the service had undertaken a review of ‘red phone calls’ to monitor how often these complied with a set format and if that correlated with a more rapid handover and preparedness by the emergency department. A "red phone" call to an emergency department (ED) is a pre-alert from an ambulance crew about a critically ill or injured patient, using a dedicated, separate-ring-tone phone It had been identified that a known risk during handover was the potential loss of mobile signal. To mitigate this, the adapted format placed the estimated time of arrival (ETA) as the first piece of information to be communicated. This ensured that even if the signal was lost mid‑handover, the department would still know when the patient was expected to arrive and could prepare accordingly. This change improved the clarity and reliability of pre‑alerts, resulting in better communication and more effective resource allocation. This work had been presented to both service staff and emergency department staff at University Southampton Hospitals. We heard from staff in both services that this was beneficial and well received.

We also heard how a pathway had been developed to take some patients directly to CT scanning, bypassing the emergency department. This was because it had been recognised that faster diagnostic imaging would mean risks could be acted upon sooner and lead to improved patient outcomes.

The service had policies and practices to ensure good communication between other agencies. The service also had effective service level agreements and memoranda of understanding with external agencies to ensure there was a clear plan of decision making and communications during incidents. This included agreements with these services to share data and provide essential patient care information. This would then be used in care reviews so the full ‘end to end’ story could be reviewed. There was quarterly feedback to the NHS ambulance service partner and the NHS provider trust.

Staff shared information about patients at shift handover meetings. These occurred twice daily to ensure essential information was known to all clinical staff. The service held annual multi organisational training to support staff development and improve joined up working. These training sessions used real examples of complex incidents with cross organisational working, so that they provided meaningful examples, The service also attended regular meetings with other emergency response providers to discuss wider operational matters.

We scored the service as 4. The evidence showed an exceptional standard. The service monitored all people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they fully met both clinical expectations and the expectations of people themselves.

Patient outcomes were gained as much as practicably possible. These were well documented with a full review process. All outcome information was reviewed and enabled the service to make changes to methods of care or improvements in communications to enhance patient outcomes. The aftercare team sought clinical follow up information for all patients taken to University Hospital Southampton NHS Trust (UHS). This information was then populated in the services database and generated an e-mail to the attending clinical and dispatch staff members. Leaders recognised ground-based NHS ambulance service staff would equally benefit from this feedback. In response to this, they generated posters and cards with a QR code through which request clinical follow up information on a patient they had cared for. Feedback from these staff was positive and welcomed the resource. These cards were also supplied to family members and loved ones.

The service was in the process of developing an information sharing agreement with services they routinely handed patients over to other than the trust. This would enable them to have a full picture of the patient journey when taken to any NHS trust in the region.

The aftercare team contacted patients or their loved ones, within two days of attending an incident. The aftercare team then arranged additional support if appropriate or necessary. Patients and their families shared their experiences with the aftercare team by emails or by phone. The aftercare team told us support was available and open ended for all patients or their loved ones. Patients and their families were provided with a full timeline of their care if they requested. They were complimentary about the prompt and effective treatment they received from the service.

Staff used technology to support patients effectively. Electronic patient records were used to document all care and treatment. Monitoring equipment gave staff continuous updates on a patient’s condition so they could be monitored, and signs of deterioration acted upon. When a patient was handed over to another team these records would be transferred in full to give receiving staff a full picture of care.

When patients did not have any identifiable information, or were unable to provide this, staff could use pre prepared profiles which gave a patient a temporary identity within the system. Temporary care profiles were based on gender and age to ensure all monitoring was as personable as possible. This would then be reconciled with their true identity once it had been determined.

The aftercare team routinely engaged with patients to monitor patient outcomes. This was shared with the leadership group and the clinicians who attended the patient. Cardiac arrest data was shared with the partnered NHS ambulance service on a monthly basis reflect so that patient survival outcomes and onward care journeys could be learned from. Aftercare staff had started following up with cardiac arrest patients to understand their experience and used the Modified Rankin Score (mRS) to access their level of disability post incident and discharge. The mRS is a 7-point scale used to measure neurological disability, it assesses a patient's ability to perform daily activities. This research had been published in the months before assessment and service hoped to further use this data to continually improve care and outcomes by reviewing the treatment they provided on scene and identify improvement.

A standard operating policy detailed the actions to be taken should a call be made from a non-UK phone number. This may happen if a person was in the UK and calling on their mobile device, which would have a non-UK prefix. If the caller was determined to not be in the UK, this would be passed to the appropriate countries’ emergency service. This was to ensure that the most appropriate service responded depending on the geographical location of the caller, and that non-UK based persons received the same care as those with UK based phone numbers.

We scored the service as 4. The evidence showed an exceptional standard. The service always carefully explained to people what their rights around consent were, making sure they fully understood them and always fully respected these when delivering person-centered care and treatment.

Staff took all practical steps to enable patients to make their own decisions. For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. Staff had access to clear policy surrounding consent and how to proceed if consent could not be gained. When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history.

We reviewed 5 care records and saw consent, in line with best practice guidance, had been gained for all patients. For patients unable to provide consent there was documentation supporting clinician decision making. We heard how decisions made in the absence of consent, for example if a patient was unconscious, would be based on giving the patient the best possible chance of recovery. Staff gave examples of incidents where they had used best interest decisions when capacity was lacking.

Patient care records were audited for compliance against the services own record keeping policy, and this included checking that consent had been gained. The audit demonstrated full compliance with policy. The service also monitored patient experience surrounding consent to ensure the views of patients supported a good experience and satisfaction with the process.

There was clear guidance in place for staff when attending incidents where a patient has an exclusion to receive life sustaining care. This included DNACPR, ReSPECT, or Advance Decision to Refuse Treatment (ADRT) agreement in place. DNACPR stands for "Do not attempt cardiopulmonary resuscitation" and is a medical decision that states a patient should not be resuscitated if their heart stops or they stop breathing. ReSPECT stands for recommended summary plan for emergency care and treatment. The ReSPECT process creates a summary of personalised recommendations for a person’s clinical care in a future emergency in which they are not able to make decisions or to express wishes.An ADRT enables someone aged 18 or over, while still capable, to refuse specified medical treatment for a time in the future when they may not be able to do so. These decisions can be based on a person's wishes or on clinical judgment, particularly when the risks of treatment outweigh the potential benefits. The policy included exclusions to consider when determining if these agreements should be followed, for example in the case of sudden trauma, allergic reaction or suicide attempt. We saw examples of staff supporting patients with these plans in place to ensure consent to care was gained and understood where possible.